Individual
GRACE HIPOLITO ALBERT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1325 SHIRLYJEAN ST, GLENDALE, CA 91208-1145
(310) 903-8034
Mailing address
1325 SHIRLYJEAN ST, GLENDALE, CA 91208-1145
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
1662
CA
Other
Enumeration date
06/02/2016
Last updated
06/02/2016
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